Odd Man Out: Sexuality, Sorrow, and the Infertile Man - by Theresa Barry Longley (Fall 2010)

ODD MAN OUT: SEXUALITY, SORROW AND THE INFERTILE MAN

by Teresa Barry Longley RN, MSN(c)
Fall 2010

The male stereotype makes masculinity not just a fact of biology but something that must be proved and re-proved, a continual quest for an ever-receding Holy Grail.
-Marc Feigen Fasteau

They have told me that they feel alone. Some worry that others will notice in the locker rooms at the gym that they are different. Others say that while they are still husbands or partners, they are no longer “mates” to their partners and they worry about being left for someone who is capable of filling the role. For some infertile men, their work, relationships and health suffer during fertility treatment and its tug-of-war between failure and success. Often isolated by the fact that most treatment is geared towards the female, the male partner moves through the fertility process like a ghost. In the clinic setting, men are often quiet or may appear disinterested in the proceedings. Some are open to questions and discussion but others resist contact, perhaps overwhelmed by a sense of failure, shame, disappointment, fear or sorrow.

In keeping with the physically intimate atmosphere of reproductive care, most programs promote couple-care on their websites, but unfortunately the treatment and care of infertility do not foster equality. The current focus on female care is due not only to the female being the host environment of procreation but also to a historical association with the female’s responsibility for fecundity. Today, the lack of successful empirical treatment for many forms of male infertility continues to affect attempts to balance treatment and care. As a result, the physical burden of treatment remains on the female partner, while the lack of designated tasks for the male may increase a sense of exclusion and worthlessness that can rarely be expressed. Marginalized and reluctant to express any weakness, men have no outlet for the stress and grief at the loss of natural procreation, and these feelings may affect many aspects of their lives, including their sexual lives.

At home, infertile men may struggle to project the stereotype of the male; powerful, silent, denying any weakness or vulnerability, disdainful of sorrow, constantly interested in sex, and most importantly, always able to protect and support the woman. But in this situation, the subfertile man finds that the one thing he can provide for the act of procreation is not enough. It is known that due to the social and cultural constructs of fertility, many wives will take on the infertility diagnosis themselves in order to protect their husbands. “It’s just easier to explain that way,” they say. But one wonders about the price their husbands pay for each word spoken. Patients tell of their husbands not wanting to know when ovulation occurs as some infertile (and some fertile) men feel such pressure that they are reluctant to engage in sexual activity at that time of the month. Many repeatedly “forget” their semen analysis appointments. Some can’t bear to do one more collection and others become unable to create erections when required. And commonly, some lose all interest in sex.

We know that for many men a lack of acceptable and accessible social support is a large part of their difficulties in finding successful coping mechanisms. There is no lunchtime gabfest for these guys as there may be for their wives. There is no context in the male world to acknowledge the male experience of infertility diagnoses, failed fertility treatments or miscarriages. Since men are known to use emotional distancing as a coping strategy and also are more likely to view their wives as their only true confidantes, these two aspects can create a sense of isolation and tension both in the relationship and in the bedroom.

So what can we say to a couple that is experiencing sexual distancing or temporary male sexual dysfunction? Well, firstly, the biggest hurdle is to acknowledge it, even if only to each other. This gets the “elephant in the room” out of the way. If the couple is unable to discuss the issue, the female partner may bring it up to a nurse or physician. Often, a quiet conversation with a clinic team member can help normalize the situation. In many programs, the educational package includes discussion of the fact that sexual distancing is common during fertility treatment and encourages couples and patients to broach the topic with a team member they are comfortable with. Many programs have counsellors on site that are able to help the man or couple find more constructive coping strategies and a return to a more fulfilling relationship. Patients have to remember that for reproductive care providers nothing is new under the sun. Sexual issues are part of the real experience of infertility and should be dealt with before a pattern is set in the relationship.

Secondly, for the man experiencing sexual dysfunction or a decrease in sexual interest, it is important to realize that for the most part this is a normal reaction to being commanded to perform sexually. Only men have to organize and publicize a private sex act, as required for a semen analysis appointment – and, while it is a routine part of clinic life, I’m sure it is not routine for most patients! Very rarely, emerging sexual dysfunction may be an indication of an underlying health issue that should be investigated by the man’s physician or nurse practitioner.

Some men are able to discuss their sexual issues with clinical staff and can learn that sorrow, anger and loss are common feelings for men experiencing infertility and that it can affect them sexually. Discussing or acknowledging their feelings about infertility and its losses can often start the healing process.

Here are some suggestions for working out the tensions that can cause sexual distancing or sexual dysfunction:

Take a month or two off from monitoring or treatment (yes, I know you wanted to be pregnant months ago, but your relationship must come first).
Acknowledge that both of you are hurting equally; men and women show hurt differently but pain is the same for everyone. Remember, men do not hurt less than women; they just hide it more.
Try only non-sexual contact for a while – handholding, or laughing together.
Change it up a bit – try to keep your clothes on, refuse to take them off – it can be fun! Or try different positions; it can be funny and … interesting.
Change the scenery – all too often the bedroom has become a place of sorrow and disappointment so keep out of it for a bit.
Take time; move in baby steps if it has been a while since the two of you were comfortable enough to be intimate. Remember when you first started dating; everything takes time. Rebuilding self-worth and intimacy does, too.

Try what I call the “five for five.” Each of you, quietly and without discussion, think of five things about yourself that make you happy. Write them down and look at them or just think about them – it doesn’t have to do with sex.It’s all about recognizing what’s great in you. Once you are comfortable with those thoughts, think about five wonderful things about your partner or spouse. Then try thinking about five things that are or were wonderful about your lives together. Then think about five things that are or were wonderful about your sexual life together. And lastly, think for five minutes about having intimate relations or activity; perhaps plan an encounter or a special evening.

Remember that the two of you are together because you love each other. That is the first and most important gift, and taking time to heal each other is a vital step to successfully building a family.

In the long run, we shape our lives, and we shape ourselves. The process never ends until we die. And the choices we make are ultimately our own responsibility.
-Eleanor Roosevelt
1884-1962

About the Author
Teresa Barry Longley, RN MSN, is a clinical nurse specialist at HEART Fertility Centre in Hamilton, Ontario. She has been practicing in reproductive care for fourteen years and has a special interest in male fertility and sexuality as well as pregnancy care of the infertile. She is a Reiki practitioner and lives in the small community of Ancaster with her patient husband, fantastic daughter, and one lovely dog.